OBJECTIVES : Considering increased burden of cost using biologic disease-modifying antirheumatic drugs (bDMARDs) and intolerance to chemical disease-modifying antirheumatic drugs (cDMARDs), using biosimilar bDMARDs monotherapy should be more considered. The objective of the study is to evaluate the cost-effectiveness of sequenced treatment with biosimilar bDMARDs compared to cDMARDs from U.S payer perspective for adult patients with moderate to severe RA and an inadequate response to cDMARDs.

METHODS : A cost-utility analysis was performed. A hypothetical cohort-based model with patients transitioned through a given treatment sequence was developed using MS Excel®. Health-related quality of life and costs were evaluated throughout the patients’ lifetimes. The model compared the sequenced biosimilar bDMARDs therapy (adalimumab – etanercept – tocilizumab – palliative therapy) with cDMARDs therapy. A six-month cycle was used in the model. After six months of first-line therapy, response to treatment was determined by American College of Rheumatology (ACR) response criteria. The proportions of individuals with different levels of ACR response on each treatment was derived from network meta-analysis. The cost of bDMARDs was based on the treatment schedule using Redbook. Administration costs, monitoring costs, and adverse events costs were included in the model. To adjust for a biosimilar, a discount rate of 20% were adjusted.

RESULTS : In the bDMARDs arm, the total lifetime cost per patient was USD 185,002, and the QALY gained per patient was 11.63. The palliative therapy arm resulted in lower lifetime costs and lower gains in QALYs per patient ( USD 25,111 and 9.16 QALY). Thus, the ICER was estimated to be USD 64,720 per QALY gained in base-case analysis. The probability to be cost-effective through WTP (willingness to pay) threshold of $50,000 was 13.0%.

CONCLUSIONS : Sequential biosimilar bDMARDs monotherapy for the treatment of moderately to severely active patients with RA can be considered cost-effective over cDMARD therapy from the US payer perspective.